PMID- 30260711
OWN - NLM
STAT- MEDLINE
DCOM- 20190409
LR  - 20211204
IS  - 1941-837X (Electronic)
IS  - 1369-6998 (Linking)
VI  - 21
IP  - 12
DP  - 2018 Dec
TI  - Cost-effectiveness of axicabtagene ciloleucel for adult patients with relapsed or 
      refractory large B-cell lymphoma in the United States.
PG  - 1238-1245
LID - 10.1080/13696998.2018.1529674 [doi]
AB  - PURPOSE: Axicabtagene ciloleucel (axi-cel) was recently approved for treatment of 
      relapsed or refractory (R/R) large B-cell lymphoma (LBCL) following two or more 
      prior therapies. As the first CAR T-cell therapy available for adults in the US, 
      there are important questions about clinical and economic value. The objective of 
      this study was to assess the cost-effectiveness of axi-cel compared to salvage 
      chemotherapy using a decision model and a US payer perspective. MATERIALS AND 
      METHODS: A decision model was developed to estimate life years (LYs), 
      quality-adjusted life years (QALYs), and lifetime cost for adult patients with 
      R/R LBCL treated with axi-cel vs salvage chemotherapy (R-DHAP). Patient-level 
      analyses of the ZUMA-1 and SCHOLAR-1 studies were used to inform the model and to 
      estimate the proportion achieving long-term survival. Drug and procedure costs 
      were derived from US average sales prices and Medicare reimbursement schedules. 
      Future healthcare costs in long-term remission was derived from per capita 
      Medicare spending. Utility values were derived from patient-level data from 
      ZUMA-1 and external literature. One-way and probabilistic sensitivity analyses 
      evaluated uncertainty. Outcomes were calculated over a lifetime horizon and were 
      discounted at 3% per year. RESULTS: In the base case, LYs, QALYs, and lifetime 
      costs were 9.5, 7.7, and $552,921 for axi-cel vs 2.6, 1.1, and $172,737 for 
      salvage chemotherapy, respectively. The axi-cel cost per QALY gained was $58,146. 
      Cost-effectiveness was most sensitive to the fraction achieving long-term 
      remission, discount rate, and axi-cel price. The likelihood that axi-cel is 
      cost-effective was 95% at a willingness to pay of $100,000 per QALY. CONCLUSION: 
      Axi-cel is a potentially cost-effective alternative to salvage chemotherapy for 
      adults with R/R LBCL. Long-term follow-up is necessary to reduce uncertainties 
      about health outcomes.
FAU - Roth, Joshua A
AU  - Roth JA
AD  - a Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer 
      Institute , Seattle , WA , USA.
AD  - b Comparative Health Outcomes, Policy and Economics Institute, School of Pharmacy 
      , University of Washington , Seattle , WA , USA.
FAU - Sullivan, Sean D
AU  - Sullivan SD
AD  - a Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer 
      Institute , Seattle , WA , USA.
AD  - b Comparative Health Outcomes, Policy and Economics Institute, School of Pharmacy 
      , University of Washington , Seattle , WA , USA.
FAU - Lin, Vincent W
AU  - Lin VW
AD  - c Kite, a Gilead Company , Santa Monica , CA , USA.
FAU - Bansal, Aasthaa
AU  - Bansal A
AD  - a Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer 
      Institute , Seattle , WA , USA.
AD  - b Comparative Health Outcomes, Policy and Economics Institute, School of Pharmacy 
      , University of Washington , Seattle , WA , USA.
FAU - Purdum, Anna G
AU  - Purdum AG
AD  - c Kite, a Gilead Company , Santa Monica , CA , USA.
FAU - Navale, Lynn
AU  - Navale L
AD  - c Kite, a Gilead Company , Santa Monica , CA , USA.
FAU - Cheng, Paul
AU  - Cheng P
AD  - c Kite, a Gilead Company , Santa Monica , CA , USA.
FAU - Ramsey, Scott D
AU  - Ramsey SD
AD  - a Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer 
      Institute , Seattle , WA , USA.
AD  - b Comparative Health Outcomes, Policy and Economics Institute, School of Pharmacy 
      , University of Washington , Seattle , WA , USA.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20181016
PL  - England
TA  - J Med Econ
JT  - Journal of medical economics
JID - 9892255
RN  - 0 (Antigens, CD19)
RN  - 0 (Biological Products)
RN  - U2I8T43Y7R (axicabtagene ciloleucel)
SB  - IM
EIN - J Med Econ. 2018 Dec;21(12):1255. PMID: 30485139
CIN - J Med Econ. 2019 Jul;22(7):613-615. PMID: 30747012
MH  - Antigens, CD19/adverse effects/economics/*therapeutic use
MH  - Antineoplastic Combined Chemotherapy Protocols/adverse 
      effects/economics/*therapeutic use
MH  - Biological Products
MH  - Cost-Benefit Analysis
MH  - Decision Support Techniques
MH  - Fees, Pharmaceutical/statistics & numerical data
MH  - Health Expenditures/statistics & numerical data
MH  - Humans
MH  - Immunotherapy, Adoptive/adverse effects/economics/*methods
MH  - Lymphoma, B-Cell/*drug therapy/mortality
MH  - Models, Econometric
MH  - Quality-Adjusted Life Years
MH  - Recurrence
MH  - Salvage Therapy/economics
MH  - Survival Analysis
MH  - United States
OTO - NOTNLM
OT  - Axicabtagene ciloleucel
OT  - C44
OT  - C53
OT  - CAR T-cell therapy
OT  - cost-effectiveness
OT  - lymphoma
EDAT- 2018/09/28 06:00
MHDA- 2019/04/10 06:00
CRDT- 2018/09/28 06:00
PHST- 2018/09/28 06:00 [pubmed]
PHST- 2019/04/10 06:00 [medline]
PHST- 2018/09/28 06:00 [entrez]
AID - 10.1080/13696998.2018.1529674 [doi]
PST - ppublish
SO  - J Med Econ. 2018 Dec;21(12):1238-1245. doi: 10.1080/13696998.2018.1529674. Epub 
      2018 Oct 16.